Surgical instrument buttress attachment

ABSTRACT

A surgical stapler instrument has surgical stapler jaws, at least one staple line reinforcement material, and a fastener including a hook and a loop. The hook can be disposed on one of the surgical stapler jaws and the loop can be disposed on the staple line reinforcement material. Alternatively, the hook can be disposed on the staple line reinforcement material and the look on one of the surgical stapler jaws.

TECHNICAL FIELD

The present disclosure relates to a buttress attachment for a surgicalinstrument, such as a surgical stapler. More particularly, the buttressis attached to one or more of the working surfaces of the surgicalinstrument utilizing a fastener.

BACKGROUND

Buttresses for surgical instruments are known. Buttresses and/or stapleline reinforcement materials include bioabsorbable, non-absorbable,synthetic and animal derived materials. Such buttress and/or staple linereinforcement materials are utilized to reduce the incidence of leaksand bleeding in a variety of surgical procedures. The use of staple linereinforcement material can reduce or eliminate suturing or clipping overstaple lines and reduce the time for the surgical procedure.

Staple line reinforcement materials have been used with linear surgicalstaplers. The material can be provided in a tubular shape and slippedonto the surgical stapler jaw. In another approach, the staple linereinforcement material is attached to the working surface of the staplerutilizing pins. See U.S. Pat. No. 6,045,560 to McKean et al., and U.S.Pat. No. 5,503,638 et al., the disclosures of which are herebyincorporated by reference herein, in their entirety.

Buttress and/or staple line reinforcement materials have also been usedwith circular staplers. The staple line reinforcement material isattached to the working surface of the circular stapler utilizingprotrusions at the perimeter of the staple line reinforcement material,the protrusions having adhesive for attaching the staple linereinforcement material to the working surfaces of the circular surgicalstapler. After tissue sections are stapled together, the buttressmaterial is attached to the tissue by the staples, with the tissuesandwiched between the staple line reinforcement material. In anotherapproach, the staple line reinforcement material is attached to theshaft of the circular stapler. See Bauman et al., U.S. Pat. No.7,547,312, U.S. Pat. No. 7,823,592, WO 03/082126, and WO 03/105698, thedisclosures of which are hereby incorporated by reference herein, intheir entirety.

One drawback to some of these approaches is that the knife of a surgicalstapler instrument is relied upon to cut the staple line reinforcementmaterial so that the instrument can be removed and the staple linereinforcement material remains with the staple line.

Drawbacks to some of these approaches include excess material that mustbe removed when the surgical instrument is withdrawn, as well asunreliable detachment of the staple line reinforcement material from thesurgical instrument.

There is a desire for improved methods of attaching staple linereinforcement material to surgical instruments so that the instrument ispackaged with the staple line reinforcement already installed, with aminimum of excess material, and a staple line reinforcement materialthat is reliably retained on the instrument while being detached fromthe instrument when the instrument is removed from the surgical site.

SUMMARY

In an aspect of the present disclosure, a surgical stapling instrument,comprising a handle assembly, a body portion, surgical stapling jaws, astaple line reinforcement material, and a fastener are disclosed. Thebody portion extends from the handle assembly and the surgical staplingjaws include a staple cartridge assembly and an anvil assembly disposedat the distal end of the body portion. The fastener has two parts, thetwo parts including a hook and a loop. At least one of the surgicalstapling jaws has one of the hook and the loop, and the staple linereinforcement material has the other of the hook and the loop.

The anvil assembly has staple forming recesses and the cartridgeassembly has staple receiving slots. The anvil assembly and thecartridge assembly may be arranged to form a circular staple line.Alternatively, the anvil assembly and the cartridge assembly may bearranged to form a linear staple line. The staple line reinforcementmaterial can be a non-woven, or the staple line reinforcement materialcan be a mesh, or other material.

In certain embodiments, the staple line reinforcement material has aplurality of pores. At least one of the surgical stapling jaws may havea plurality of hooks that are arranged to engage the plurality of pores.

In certain embodiments, the fastener includes a sheet having a pluralityof hooks on a first side and an adhesive on a second side, the adhesivebeing attached to at least one of the surgical stapler jaws, and thestaple line reinforcement material having a plurality of loops arrangedto engage the plurality of hooks.

The anvil assembly and the cartridge assembly may be arranged to form acircular staple line and the instrument can further comprise a circularknife disposed inwardly of the circular staple line. The staple linereinforcement material can be circular in shape and have a centralorifice.

In certain embodiments, the hook is disposed on at least one of thesurgical stapler jaws and has a glass transition temperature at or neara human body temperature. The hook can be disposed on at least one ofthe surgical stapler jaws and have a glass transition temperature andthe instrument can further comprise at least one thermistor for heatingthe hook to a temperature at or near the glass transition temperature.

In certain embodiments, the hook has a first base end and a second freeend, a diameter of the first base end being greater than a diameter ofthe second free end so that the second free end is relatively flexible.

The staple line reinforcement material may have a plurality of fibers,at least one of the surgical stapler jaws having the hook, and the hookbeing arranged to engage one or more of the plurality of fibers.

In another aspect of the present disclosure, a surgical staplinginstrument comprises a handle assembly, a body portion extending fromthe handle assembly, surgical stapling jaws including a staple cartridgeassembly and an anvil assembly disposed at the distal end of the bodyportion. The staple cartridge assembly has a first tissue contactingsurface and the anvil assembly having a second tissue contactingsurface. A plurality of hooks is attached to at least one of the firsttissue contacting surface and the second tissue contacting surface. Astaple line reinforcement material is in engagement with at least someof the plurality of hooks.

The staple line reinforcement material may define a plurality of pores,the plurality of hooks being arranged to engage the staple linereinforcement material in the plurality of pores.

The staple line reinforcement material may be non-woven. Alternatively,the staple line reinforcement material is a mesh or other material.

In certain embodiments, the fastener includes a sheet having a pluralityof hooks on a first side and an adhesive on a second side.

The anvil assembly has staple forming recesses and the cartridgeassembly has staple receiving slots. The anvil assembly and thecartridge assembly may be arranged to form a circular staple line.Alternatively, the anvil assembly and the cartridge assembly may bearranged to form a linear staple line.

The anvil assembly and the cartridge assembly may be arranged to form acircular staple line and the instrument can further comprise a circularknife disposed inwardly of the circular staple line. The staple linereinforcement material can be circular in shape and have a centralorifice.

In certain embodiments, the hooks have has a glass transitiontemperature at or near a human body temperature. The hooks can bedisposed on at least one of the surgical stapler jaws and have a glasstransition temperature and the instrument can further comprise at leastone thermistor for heating the hooks to a temperature at or near theglass transition temperature.

In certain embodiments, the hooks have a first base end and a secondfree end, a diameter of the first base end being greater than a diameterof the second free end so that the second free end is relativelyflexible.

In a further aspect of the present disclosure, a surgical staplinginstrument comprises a handle assembly, a body portion extending fromthe handle assembly, surgical stapling jaws including a staple cartridgeassembly and an anvil assembly disposed at the distal end of the bodyportion. The staple cartridge assembly has a first tissue contactingsurface and the anvil assembly having a second tissue contactingsurface. At least one of the first tissue contacting surface and thesecond tissue contacting surface has a plurality of hooks. A staple linereinforcement material is in engagement with at least some of theplurality of hooks.

The staple line reinforcement material may include a plurality offibers, the plurality of hooks being arranged to engage at least some ofthe plurality of fibers of the staple line reinforcement material. Thestaple line reinforcement material may be non-woven. Alternatively, thestaple line reinforcement material is a mesh.

In certain embodiments, the instrument has a sheet having a plurality ofhooks on a first side and an adhesive on a second side.

The anvil assembly has staple forming recesses and the cartridgeassembly has staple receiving slots. The anvil assembly and thecartridge assembly may be arranged to form a circular staple line.Alternatively, the anvil assembly and the cartridge assembly may bearranged to form a linear staple line.

The anvil assembly and the cartridge assembly may be arranged to form acircular staple line and the instrument can further comprise a circularknife disposed inwardly of the circular staple line. The staple linereinforcement material can be circular in shape and have a centralorifice.

In certain embodiments, the hooks have a glass transition temperature ator near a human body temperature. The hooks can be disposed on at leastone of the surgical stapler jaws and have a glass transition temperatureand the instrument can further comprise at least one thermistor forheating the hooks to a temperature at or near the glass transitiontemperature.

In certain embodiments, the hooks have a first base end and a secondfree end, a diameter of the first base end being greater than a diameterof the second free end so that the second free end is relativelyflexible.

In a further aspect of the present disclosure, a surgical staplinginstrument comprises a handle assembly, a body portion extending fromthe handle assembly, surgical stapling jaws including a staple cartridgeassembly and an anvil assembly disposed at the distal end of the bodyportion. The staple cartridge assembly has a first tissue contactingsurface and the anvil assembly having a second tissue contactingsurface. The instrument includes a sheet having an adhesive at a firstside of the sheet and at the second side of the sheet. At least one ofthe first tissue contacting surface and the second tissue contactingsurface has the first side of the sheet attached thereto so that thesecond side of the sheet is accessible for placement of a staple linereinforcement material thereon. In certain embodiments, the first tissuecontacting surface defines rows of staple receiving slots the sheet isattached outwardly of rows of staple receiving slots. In certainembodiments, the first tissue contacting surface defines annular rows ofstaple receiving slots and the sheet is attached outwardly of the rowsof staple receiving slots. Additionally or alternatively, the firsttissue contacting surface defines annular rows of staple receiving slotsand the sheet is attached inwardly of the rows of staple receivingslots. In certain embodiments, one or more sheets are attached to thesecond tissue contacting surface. In certain embodiments, the adhesiveof the first side of the sheet is selected to so as to maintain thesheet attached to the at least one of the first tissue contactingsurface and the second tissue contacting surface as the instrument isremoved from a surgical site. The adhesive of the second side of thesheet is selected so as to allow the staple line reinforcement materialto be released from the sheet.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the presentdisclosure and, together with a general description of the disclosuregiven above and the detailed description of the embodiments given below,serve to explain the principles of this disclosure, wherein:

FIG. 1 is a perspective view of a surgical stapler instrument accordingto an embodiment of the present disclosure;

FIG. 2 is a perspective view of an anvil assembly and staple cartridgeassembly according to the embodiment of FIG. 1;

FIG. 3 is a perspective view of an anvil assembly and staple cartridgeassembly according to the embodiment of FIGS. 1 and 2;

FIG. 4 is a perspective view of a tissue contacting surface of acartridge assembly according to the embodiment of FIGS. 1 through 3;

FIG. 5 is a perspective view of a tissue contacting surface of an anvilassembly according to the embodiment of FIGS. 1 through 4;

FIG. 6 is a perspective view of a plurality of hooks in accordance withfurther embodiments of the present disclosure;

FIG. 7 is a view in elevation of a staple line reinforcement materialattached to a plurality of hooks in accordance with the embodiment ofFIGS. 1 through 5;

FIG. 8 is a perspective view of a staple line reinforcement material inaccordance with the embodiment of FIGS. 1 through 5 and 7;

FIG. 9 is a perspective view of a surgical stapler instrument accordingto another embodiment of the present disclosure;

FIG. 10 is a perspective view of the tissue contacting surface of astaple cartridge assembly in accordance with the embodiment of FIG. 9;

FIG. 11 is a perspective view of the tissue contacting surface of ananvil assembly in accordance with the embodiment of FIGS. 9 and 10;

FIG. 12 is a perspective view of a staple line reinforcement material inaccordance with the embodiment of FIGS. 9 through 11;

FIG. 13 is a perspective view of a sheet in accordance with theembodiment of FIGS. 9 through 12;

FIG. 14 is a perspective view of a sheet in accordance with a furtherembodiment of the present disclosure;

FIGS. 15 a through 15 e are cross-sectional views of engaging featuresformed on one or more tissue contacting surfaces of a surgical staplinginstrument in accordance with another embodiment of the presentdisclosure;

FIG. 16 is a perspective view of a tissue contacting surface of acartridge assembly according to the embodiment of FIGS. 15 a through 15e;

FIG. 17 is a plan view of a tissue contacting surface of an anvilassembly according to the embodiment of FIGS. 15 a through 16; and

FIG. 18 is a view in elevation of a staple line reinforcement materialattached to a plurality of hooks in accordance with the embodiment ofFIG. 15 a through FIG. 17.

DETAILED DESCRIPTION

Embodiments of the presently disclosed devices and structures will nowbe described in detail with reference to the drawing figures whereinlike reference numerals identify similar or identical elements. As usedherein and as is traditional, the term “distal” refers to that portionwhich is furthest from the user while the term “proximal” refers to thatportion which is closest to the user.

FIG. 1 illustrates a circular surgical stapling instrument which isgenerally designated as 10. Surgical stapling device 10 includes ahandle assembly 12 having at least one pivotable actuating handle 14 anda rotatable actuator 18. A tubular body portion 20 extends from thehandle assembly 12. The tubular body portion 20, which generally has acircular cross-sectional shape, may have a straight or a curved shapealong its length and may be flexible or relatively rigid.Cross-sectional shapes other that circular are contemplated, so that thetubular body portion 20 can have a polygonal, elliptical, semi-circular,ovoid, or other shape. Surgical stapling jaws including a staplecartridge assembly and an anvil assembly are disposed at a distal end ofthe body portion. The body portion 20 terminates in a staple cartridgeassembly 22 that has a tissue contacting surface defining one or morerows 37 of staple receiving slots 36. Each staple receiving slot has astaple (not shown) disposed therein. Typically, a pair of circular rows37 of staple receiving slots 36 is provided, although other shapes, suchas annular, are contemplated. An anvil assembly 30 is positioneddistally of the staple cartridge assembly 22, which includes an anvilmember 26 and a shaft 28 operatively associated therewith. The anvilassembly has a tissue contacting surface that defines staple formingrecesses that correspond to the circular rows of staple receiving slots,so that the stapling instrument forms circular staple lines. The tubularbody portion 20 has a corresponding rod or shaft 40 centrally locatedwith respect to the staple cartridge assembly 22. The shaft 28 isremovably connectable to the shaft 40 of the tubular body portion 20.

The staple cartridge assembly 22 is connectable to the distal end oftubular body portion 20 or may be configured to concentrically fitwithin the distal end of tubular body portion 20. Typically, staplecartridge assembly 22 includes a staple pusher (not shown) with a distalportion defining two concentric rings of peripherally spaced fingers(not shown), each one of which is received within a respective staplereceiving slot 36.

Typically, a knife (not shown) having a cutting edge is disposed withinthe staple cartridge assembly 22. The knife edge is circular anddisposed radially inward of the rows of staples. The knife is mounted sothat as the staple pusher is advanced axially in the direction of theanvil assembly, the knife is also advanced axially. The staple pusher isadvanced in the distal direction to drive staples from the staplereceiving slots 36 against the anvil member so that the staple formingrecesses form the staples in a closed shape. As the pusher is advanced,the knife is advanced and driven toward the anvil assembly 30 to cuttissue.

U.S. Pat. No. 5,915,616 to Viola et al., the entire content of which ishereby incorporated by reference herein in its entirety, discloses acircular stapling device. Although a circular stapling apparatus isshown in FIG. 1, the stapling device may be arranged to deploy staplesin a semi-circular or other desired shape. Although discussed withreference to intestinal tissue, devices according to the presentdisclosure can be arranged to join and/or treat other tissues in otherprocedures.

As shown in FIGS. 2 and 3, the anvil assembly 30 is detached from therod or shaft 40 of the tubular body portion 20 and a section of tubularbody vessel, such as a section of intestine, is secured to the anvilassembly 30, typically by tying a suture “P” around the shaft 28 of theanvil assembly 30. Another section of tubular tissue is secured to thetubular body portion 20 by tying a suture around the shaft 40. See FIG.2. The shaft 28 is then connected to the shaft 40. The actuator 18 isrotated to withdraw the shafts 28, 40 thereby approximating the anvilassembly 30 with the staple cartridge assembly 22. To fire the staples,the handles 14 are squeezed, which advances the staple pusher and theknife (not shown). The staples pass through each section of tubulartissue and are formed against the anvil so that the sections of tubulartissue are joined to one another. The knife cuts the tissue radiallyinward of the rows of staples, and the sutured material is removed withthe circular stapling device.

Disclosed herein is a surgical stapling instrument 10, and staple linereinforcement material 50 fastened thereto. The surgical staplinginstrument has surgical stapling jaws comprising the anvil assembly 30and the staple cartridge assembly 22, each having a tissue contactingsurface that engages the tissue. The tissue contacting surface 41 of thestaple cartridge assembly 22 defines the staple receiving slots 36,whereas the tissue contacting surface 42 of the anvil assembly 30defines staple forming recesses 31.

A staple line reinforcement material (“SLRM”) 50 can be attached to thesurface 41, the surface 42, or both. Desirably, the SLRM 50 is attachedto one or more tissue contacting surfaces before the surgical staplinginstrument is packaged, so that the surgeon and/or operating roompersonnel are not required to install the SLRM onto the surgicalstapling instrument before the surgery. However, installation of theSLRM just prior to the surgery is also contemplated.

The SLRM 50 and the surgical stapling instrument 10 define a fastener 32having two parts. The first part is a hook, or a plurality of hooks 35,and the second part is a loop, or a plurality of loops 37. The hook orhooks 35 can be provided on the surgical stapler jaw and the loop orloops 37 can be provided on the SLRM 50. Alternatively, the hook orhooks are provided on the SLRM and the loop or loops are provided on thesurgical stapler jaws. See FIG. 7.

In certain preferred embodiments, the SLRM 50 comprises a materialhaving a plurality of pores 52 and the hooks 35 comprises fiber hooksthat are applied to the surface 41 of the staple cartridge assembly 22and to the surface 42 of the anvil assembly 30. The hooks can be formedfrom a polymer, metallic materials such as steel, etc. The hooks engagethe SLRM in the pores. The pores can be formed as apertures in a sheetof material, or recesses, or the pores can comprise openings definedbetween fibers, threads wires, etc. that makeup the SLRM.

A sheet 45 a having a plurality of fiber hooks 35 a on a first side 46and an adhesive material 43 on a second side 48 is applied to theworking surface 41 of the staple cartridge assembly 22. The sheet 45 ais circular in shape and has a central orifice 47 with a diameter D1.The diameter D1 is larger than an outer diameter D2 of the rows 37 ofstaple receiving slots 36. Another sheet 45 b has hooks 35 and iscircular in shape and has an outer diameter that is smaller than aninner diameter D4 of the rows 37 of staple receiving slots 36. Each ofthe sheets 45 a and 45 b are adhered to the working surface 41 so thatthey do not overly the staple receiving slots 36. See FIGS. 4 and 7. Theadhesive material is selected so that the adherence of the sheet to theinstrument is strong enough so that the sheet is retained with theinstrument after the staples have been fired and the tissue has beencut.

A sheet 55 a having a first side with an adhesive material and a secondside having a plurality of fiber hooks is attached to the workingsurface 42 of the anvil assembly 30 so that the sheet 55 a liesoutwardly of the staple forming recesses 31. Another sheet 55 b with afirst side having an adhesive material and a second side with aplurality of loops is attached to the working surface 42 of the anvilassembly 30 so that it lies inwardly of the staple forming recesses. SeeFIG. 5.

The SLRM 50 is a circular piece of porous material having a centralorifice for accommodating the shaft 28 and shaft 40. See FIG. 8. TheSLRM 50 is applied to the working surface 41 and the working surface 42by pressing the SLRM 50 against the hooks 35 on the working surfaces 41and 42. The hooks 35 engage the SLRM 50 in the pores 52 therebyretaining the SLRM 50 against the working surface 41 of the staplecartridge assembly 22 and the working surface 42 of the anvil assembly30. The SLRM 50 is sized to overlie the working surfaces of the staplecartridge assembly 22 and the anvil assembly 30. The SLRM 50 and thesheets 45 a, 45 b, 55 a, 55 b do not interfere with the operation of thepusher or the knife, as the SLRM has a central orifice 51 that has adiameter that is larger than the diameter of the knife.

It is contemplated that the area of attachment, hook density, hook fiberstrength, hook fiber length, and the pressing of the SLRM onto the hookscan be optimized to ensure retention of the SLRM and also easy releaseof the SLRM after the surgical stapling instrument is fired.

It is contemplated that the SLRM 50 may be fabricated from or include asurgical grade, biocompatible, non-absorbable material and may comprisea mesh. For example, the SLRM 50 may be fabricated from “TEFLON”, whichis a registered trademark owned by DuPont de Nemours & Co. It is furthercontemplated that body portion 102 may be fabricated from abiocompatible polymeric foam, felt, polytetrafluoroethylene (ePTFE),gelatin, fabric or the like, or any other biocompatible material.

Non-absorbable materials used for SLRM include, and are not limited to,those that are fabricated from such polymers as polyethylene,polypropylene, nylon, polyethylene terephthalate,polytetrafluoroethylene, polyvinylidene fluoride, and the like. Furthernon-absorbable materials include and are not limited to stainless steel,titanium and the like.

In one embodiment, the SLRM 50 may be fabricated from a bio-absorbablematerial. In other embodiments, the SLRM has at least one portion thatis absorbable and at least one portion that is not absorbable.Bio-absorbable materials used for SLRM include, and are not limited to,those fabricated from homopolymers, copolymers or blends obtained fromone or more monomers selected from the group consisting of glycolide,glycolic acid, lactide, lactic acid, p-dioxanone, α-caprolactone andtrimethylene carbonate. Other bio-absorbable materials include and arenot limited to, for example, Polyglycolic Acid (PGA) and Polylactic Acid(PLA). In one embodiment, the SLRM may be fabricated from bio-absorbablefelt, gelatin or any other bio— absorbable materials.

The SLRM 50 can incorporate a wound treatment material “W”, whichincludes and is not limited to one or a combination of adhesives,hemostats, sealants, coagulants, astringents, and medicaments. Othersurgically biocompatible wound treatment materials “W” which may beemployed in or applied by surgical instruments, including surgicalstaplers, include adhesives whose function is to attach or hold organs,tissues or structures; sealants to prevent fluid leakage; hemostats tohalt or prevent bleeding; coagulants, astringents (e.g., sulfates ofaluminum) and medicaments. Examples of adhesives which can be employedinclude protein derived, aldehyde— based adhesive materials, forexample, the commercially available albumin/glutaraldehyde materialssold under the trade designation BioGlue™ by Cryolife, Inc., andcyanoacrylate-based materials sold under the trade designationsIndermil™ and Derma Bond™ by Tyco Healthcare Group, LP and EthiconEndosurgery, Inc., respectively. Examples of sealants, which can beemployed, include fibrin sealants and collagen-based and syntheticpolymer-based tissue sealants. Examples of commercially availablesealants are synthetic polyethylene glycol-based, hydrogel materialssold under the trade designation CoSeal™ by Cohesion Technologies andBaxter International, Inc. Examples of hemostat materials, which can beemployed, include fibrin-based, collagen-based, oxidized regeneratedcellulose-based and gelatin-based topical hemostats. Examples ofcommercially available hemostat materials are fibrinogen-thrombincombination materials sold under the trade designations CoStasis™ byTyco Healthcare Group, LP, and Tisseel™ sold by Baxter International,Inc. The W can include medicaments. Medicaments may include one or moremedically and/or surgically useful substances such as drugs, enzymes,growth factors, peptides, proteins, dyes, diagnostic agents orhemostasis agents, monoclonal antibodies, or any other pharmaceuticalused in the prevention of stenosis.

The SLRM may include a single layer including a homogeneous array ofbio-absorbable or non-absorbable materials or a heterogeneous array ofbio-absorbable and/or non-absorbable materials. The SLRM may include alayered body portion having at least two layers as indicated by firstlayer, film or wafer and second layer, film or wafer. In thisembodiment, each layer may include a homogeneous or heterogeneous arrayof bio-absorbable and/or non-absorbable materials.

In certain preferred embodiments, the SLRM is a non-woven fabric. Thenon-woven fabric can be formed utilizing a melt blown process, includingthe following steps. The polymer resin is melt extruded. A melt pumpmeters out the molten polymer to a die head having an array of holes. Byway of example, the holes have a diameter of between about 0.175 andabout 0.25 millimeters. The polymer is forced through the array of holesin the die. Polymer fibers exit the die and are forced onto a conveyorbelt. A stream of blowing hot air can be used to force the polymerfibers onto the conveyor. Suction through the conveyor belt surface canbe used to compact the fibers against the belt and against each other,as the fibers cool. Additional compression may be applied to the fibers,such as by using a calendaring roll, which may include heating orcooling. The non-woven fabric may then be annealed. For example,isometric tension or other uniform compression can be used to drivecrystallization and remove the monomer. The polymer is desirably abioabsorbable or non-bioabsorbable polymer, such as a glycolide lactidecopolymer (the material utilized in Polysorb™ sutures), a termpolymercomposed of glycolide, trimethylene carbonate and dioxanone (thematerial utilized in Biosyn™ sutures), a polymer of glycolide,caprolactone, trimethylene carbonate, and lactide (the material utilizedin Caprosyn™ sutures), and a glycolide trimethylene carbonate copolymer(the material utilized in Maxon™ sutures).

In certain embodiments, the non-woven fabric is porous. For example, thenon-woven fabric can have a porousity of between about 50% and about90%. The fiber diameter may be between about 5 and about 100 μm. Thefabric thickness may be between about 150 and about 400 μm.

In other embodiments of the present disclosure, the SLRM 50 has thehooks 35 disposed on a surface thereof, and the loops 39 are attached tothe tissue contacting surface 41 and/or tissue contacting surface 42.

In certain embodiments, the sheets 45 a, 45 b, 55 a, and/or 55 b, or theSLRM 50, have hooks 35 are fabricated from a polymer having a glasstransition temperature at or near a human body temperature. When thesurgical stapler instrument is utilized in the body, the stapler jawswill be approximated with one another to clamp on tissue. The hooks willwarm and soften so that the SLRM 50 is more easily removed after thestaples have been fired, but the hooks 35 are initially relatively rigidto retain the material 50 on the surgical stapler instrument 10. Thesurgical instrument can include thermistors for heating the hooks sothat they soften when heated at some predetermined temperature which maybe below or above body temperature.

In a further embodiment, the hooks 35 discussed above are formed of ashape memory polymer with shape shifting capacity at about 50 degreesCentigrade. Alternatively, the surgical stapler instrument 10 caninclude thermistors for heating the hooks 35 above 50 degreesCentigrade. Alternatively, the heat of a human body (about 37Centigrade) could alter the shape of the shape memory polymer hooks toallow easier release of the SLRM 50. The heating of the hooks 35 causesa change in shape that allows the SLRM to be more easily removed fromthe surgical stapler instrument 10. For example, the heating can causethe hooks 35 to change from a hook configuration to a straight, orsubstantially straight, configuration.

In a further embodiment, any of the hooks 35 discussed above has a firstbase end 1 and a second free end 2. A diameter “d1” of the first baseend is greater than a diameter “d2” of the second free end so that thesecond free end is relatively flexible. The base end is relativelystiff. See FIG. 7. The geometry of the hooks 35 is tailored so that thelifting force is reduced and the SLRM will be released more easily afterthe surgical stapler instrument is fired. The hooks 35 can have avariety of shapes, including polygonal, tubular, tapering, arrow-shaped,etc. See FIG. 6.

In a further embodiment, the surgical instruments discussed herein havea staple line reinforcement material has a plurality of fibers and atleast one of the surgical stapler jaws has the hooks 35. The hooks arearranged to engage one or more of the plurality of fibers to releasablyretain the SLRM on the stapler jaws.

FIG. 9 illustrates a linear stapling instrument 100 having stapler jaws110, 120. The stapler jaw 110 is a staple cartridge assembly having oneor more rows 137 of staple receiving slots 136. Each staple receivingslot has a staple (not shown) disposed therein. Typically, three linearrows 137 of staple receiving slots 136 are provided on either side of achannel 139. An anvil assembly 130 is positioned in opposition to thestaple cartridge assembly 122 and pivotably mounted so that the anvilassembly and staple cartridge assembly can be approximated to clamptissue therebetween. The anvil assembly includes an anvil member 126defining a plurality of staple forming recesses 131 that correspond tothe linear rows 137 so that the stapling instrument forms linear staplelines. The stapling jaws 110, 120 are disposed at a distal end of anendoscopic shaft 140. A handle assembly 101 includes a pivotable handle103 that drives movement of a drive member through the staple cartridgeassembly 122. The drive member (not shown) passes through the channel139 and pushes a sled or camming bar through the staple cartridge todrive staple pushers, and the staples, through the slots 136 toward thestaple forming recesses of the anvil member 126. Such a surgicalinstrument is disclosed in U.S. Pat. No. 6,241,139 to Milliman et al.,the disclosure of which is hereby incorporated by reference herein, inits entirety.

The stapling instrument has a staple line reinforcement material 150fastened thereto. The staple cartridge assembly 122 and the anvilassembly 130 each have a tissue contacting surface that engages thetissue. The tissue contacting surface 141 of the staple cartridgeassembly 122 defines the staple receiving slots 136, whereas the tissuecontacting surface 142 of the anvil assembly 130 defines staple formingrecesses 131.

A SLRM 150 can be attached to the surface 141, the surface 142, or both.See FIG. 12. Desirably, the SLRM 150 is attached to one or more tissuecontacting surfaces before the surgical stapling instrument is packaged,so that the surgeon and/or operating room personnel are not required toinstall the SLRM onto the surgical stapling instrument before thesurgery. However, installation of the SLRM just prior to the surgery isalso contemplated.

The SLRM 150 and the surgical stapling instrument 110 define a fastener132 having two parts. The first part is a hook, or a plurality of hooks135, and the second part is a loop, or a plurality of loops 137. Thehook or hooks 135 can be provided on the surgical stapler jaw and theloop or loops 137 can be provided on the SLRM 150. Alternatively, thehook or hooks are provided on the SLRM and the loop or loops areprovided on the surgical stapler jaws.

In certain preferred embodiments, the SLRM 150 comprises a materialhaving a plurality of pores 152 and the hooks 135 comprise fiber hooksthat are applied to the surface 141 of the staple cartridge assembly 22and/or to the surface 142 of the anvil assembly 130. The hooks can beformed from a polymer, a metallic material such as steel, etc. A sheet145 having a plurality of fiber hooks 135 on a first side 146 and anadhesive material 143 on a second side 148 is applied to the tissuecontacting surface 141 of the staple cartridge assembly 122. The sheet145 is generally rectangular or oblong in shape and lies outside therows 137 of staple receiving slots. For example, at least one firstsheet 145 a is disposed at a distal end of the working surface 141 andat least one second sheet 145 b is disposed at a proximal end of theworking surface 141. The sheets 145 are adhered to the working surface141 so that they do not overly the staple receiving slots 136. See FIG.10.

At least one first sheet 155 a having a first side with an adhesivematerial and a second side having a plurality of fiber hooks is attachedto the tissue contacting surface 142 of the anvil assembly 130, at adistal end of the surface 142. At least one second sheet 155 b is alsoattached at the proximal end of the surface 142. The sheets lieoutwardly of the staple forming recesses 131. See FIG. 11.

The SLRM 150 is a generally rectangular piece of porous material. A SLRM150 is applied to each of the surface 141 and the surface 142 bypressing a SLRM 150 against the hooks 135 on the tissue contactingsurface 141 and pressing another SLRM against the hooks on the tissuecontacting surface 142. The hooks 135 engage the SLRM 150 in the pores152 thereby retaining the SLRM 150 against the working surface 141 ofthe staple cartridge assembly 122 and the working surface 142 of theanvil assembly 130. The SLRM 150 is sized to overlie the workingsurfaces of the staple cartridge assembly 122 and the anvil assembly130. The SLRM 150 and the sheets 145, 155 do not interfere with theoperation of the pusher or the knife. The knife, which is carried by thedrive member of the stapling instrument 100, divides the SLRM,separating the SLRM into two parts.

In another embodiment, the SLRM 150 is attached to the surface 141, thesurface 142, or both utilizing a sheet (145, 155) that is elongate inshape and extends alongside the rows 137 of staple receiving slots 136,the staple forming recesses 131, or both. One or more elongate sheetscan be applied to the surface 141 and/or surface 142. Hooks 135 on thesheet or sheets attach the SLRM to the surface 141 and/or surface 142.

SLRM 150 comprises a material having a plurality of pores 152.Alternatively, the SLRM 150 comprises a material having a plurality offibers, or any of the other materials discussed above. The hooks 135that are attached to surface 141 and surface 142 engage the SLRM in thepores or the fibers of the SLRM, as discussed above.

It is contemplated that the area of attachment, hook density, hook fiberstrength, hook fiber length, and the pressing of the SLRM onto the hookscan be optimized to ensure retention of the SLRM and also easy releaseof the SLRM after the surgical stapling instrument is fired.

In a further embodiment, the surgical stapling instrument 100 hassurgical stapling jaws, a staple line reinforcement material, and anattachment sheet 245 having a first side 246 and a second side 248 withan adhesive thereon. The SLRM 50 is attached to the first side 246 bythe adhesive and the second side 248 is attached to the tissuecontacting surface of at least one of the circular surgical staplingjaws. The surgical stapling jaws include an anvil assembly and acartridge assembly. In certain embodiments, the anvil assembly and thecartridge assembly are arranged to form a circular staple line. In otherembodiments, the anvil assembly and the cartridge assembly are arrangedto form a linear staple line.

The attachment sheet 245, as depicted in FIG. 14, has a rectangular oroblong shape and one or more attachment sheets 245 can be placed on theworking surface 41 of the staple cartridge assembly 22 to attach theSLRM to the working surface 41. In certain embodiments, the sheet orsheets 245 are placed outwardly of the rows 37 of staple receiving slots36 defined by the surface 41 and may also be placed inwardly of the rows37 of staple receiving slots 36. In other embodiments, the attachmentsheet is circular in shape, with an orifice that is dimensioned to belarger than the staple retaining slots or staple forming recesses.Another sheet dimensioned to be smaller than the slots and/or rows canbe used.

One or more attachment sheets can be placed on the tissue contactingsurface 42 of the anvil assembly 30 to attach the SLRM to the surface42. In certain embodiments, the sheet or sheets 245 are placed outwardlyof the staple forming recesses 31 defined by the working surface 42 andmay also be placed inwardly of the staple forming recesses 31 to attacha SLRM to the anvil assembly.

In a further embodiment, the sheet 245 having a first side 246 and asecond side 248 with an adhesive thereon can be attached to the workingsurface 141 and/or working surface 142. The SLRM 150 is attached to thefirst side 246 by the adhesive and the second side 248 is attached tothe working surface of at least one of the surgical stapling jaws. Theadhesive on the first side 246 is selected to allow the SLRM to bereleased from the instrument after firing of staples and cutting oftissue so that the SLRM will remain with the stapled tissue and theinstrument can be removed. Conversely, the second side has an adhesivethat is selected to maintain the sheet 245 attached to the instrument asthe instrument is removed. The adhesive sheet 245 can be used withinstrument 10 or instrument 100 discussed above, or other surgicalstapling instruments.

In another embodiment, the SLRM 150 is attached to the working surface141, the working surface 142, or both utilizing a sheet (145, 155) thatelongate in shape and extends alongside the rows 137 of staple receivingslots 136, the staple forming recesses 131, or both. One or moreelongate sheets can be attached to the working surface 142 and/orworking surface 142 by adhesive and the SLRM can be attached to thesheet or sheets by adhesive.

In a further embodiment, the surgical stapling instrument 10 or thesurgical stapling instrument 100, or another stapling instrument, has ahandle assembly, a body portion extending from the handle assembly,surgical stapling jaws including a staple cartridge assembly and ananvil assembly disposed at a distal end of the body portion, and astaple line reinforcement material (SLRM). At least one of a tissuecontacting surface of the staple cartridge assembly and a tissuecontacting surface of the anvil assembly incorporates hooks or otherengaging features formed in the staple cartridge assembly and/or anvilassembly so that the hooks or engaging features extend from, or recedeinto, the tissue contacting surface of the staple cartridge assemblyand/or anvil assembly. FIGS. 15 a through 15 e illustrate various shapesfor features that can be utilized as hooks or engaging features forengaging a SLRM and retaining the SLRM onto the stapling instrument. Thehooks or engaging features are formed as a part of the anvil and/orcartridge surfaces as molded or stamped and/or machined features.Typically, the staple cartridge assembly includes a body molded from apolymeric material, whereas the anvil assembly is formed from one ormore parts that are stamped and/or machined from metal. The hooks orengaging features would have geometries that could be made through thesepart forming methods. Other manufacturing methods can be used.

The SLRM 350 comprises a material having a plurality of pores 352 orfibers 353 that are engaged by the hooks or engaging features 335 at thetissue contacting surface 341 of the staple cartridge assembly 322 andat the tissue contacting surface 342 of the anvil assembly 330. Thepores can be formed as apertures in a sheet of material, or recesses, orthe pores can comprise openings defined between fibers, threads wires,etc. that makeup the SLRM.

The hooks or engaging features 335 are formed across the tissuecontacting surface 341 and/or tissue contacting surface 342.Alternatively, the hooks or engaging features 335 are formed so that thehooks or engaging features 335 are disposed outwardly of linear staplelines, or outwardly and/or inwardly of circular staple lines. The SLRM350 can be a circular piece of material having a central orifice foraccommodating the shafts of a circular stapling instrument.Alternatively, the SLRM 350 is rectangular or oblong in shape for beingdisposed on a linear surgical stapling instrument. In certainembodiments, the SLRM 350 is applied to the tissue contacting surfacesof the staple cartridge assembly and/or the anvil assembly by pressingthe SLRM 350 against the hooks or engaging features 335 on the tissuecontacting surfaces. The hooks or engaging features 335 engage the SLRM350 in the pores 352 or at fibers 353 thereby retaining the SLRM 350against the tissue contacting surfaces. The SLRM is sized to overlie thetissue contacting surfaces of the staple cartridge assembly and theanvil assembly. The SLRM can be formed from the materials discussedabove and the hooks or engaging features, and the pores or fibers of theSLRM, are sized to enable the hooks or engaging features to engage atleast some of the pores or fibers in the SLRM to retain the SLRM untilthe instrument is fired and is removed.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, the surgical staplinginstrument need not apply staples but rather may apply two partfasteners as is known in the art. Further, the length of the linear rowof staples or fasteners, or the length or diameter of a circular row ofstaples or fasteners, may be modified to meet the requirements of aparticular surgical procedure. Therefore, the above description shouldnot be construed as limiting, but merely as exemplifications ofpreferred embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appendedthereto.

1. A surgical stapling instrument, comprising: a handle assembly; a bodyportion extending from the handle assembly; surgical stapling jawsincluding a staple cartridge assembly and an anvil assembly disposed ata distal end of the body portion; a staple line reinforcement material;and a fastener having two parts, the two parts including a hook and aloop, at least one of the surgical stapling jaws having one of the hookand the loop, and the staple line reinforcement material having theother of the hook and the loop.
 2. The surgical stapling instrumentaccording to claim 1, wherein the anvil assembly having staple formingrecesses and the cartridge assembly has staple receiving slots.
 3. Thesurgical stapling instrument according to claim 2, wherein the anvilassembly and the cartridge assembly are arranged to form a circularstaple line.
 4. The surgical stapling instrument according to claim 2,wherein the anvil assembly and the cartridge assembly are arranged toform a linear staple line.
 5. The surgical stapling instrument accordingto claim 1, wherein the staple line reinforcement material is non-woven.6. The surgical stapling instrument according to claim 1, wherein thestaple line reinforcement material is a mesh.
 7. The surgical staplinginstrument according to claim 1, wherein the staple line reinforcementmaterial has a plurality of pores.
 8. The surgical stapling instrumentaccording to claim 7, wherein at least one of the surgical stapling jawshas a plurality of hooks that are arranged to engage the plurality ofpores.
 9. The surgical stapling instrument according to claim 1, whereinthe fastener includes a sheet having a plurality of hooks on a firstside and an adhesive on a second side, the adhesive being attached to atleast one of the surgical stapler jaws, and the staple linereinforcement material having a plurality of loops arranged to engagethe plurality of hooks.
 10. The surgical stapling instrument accordingto claim 1, wherein the anvil assembly and the cartridge assembly arearranged to form a circular staple line and further comprising acircular knife disposed inwardly of the circular staple line.
 11. Thesurgical stapling instrument according to claim 10, wherein the stapleline reinforcement material is circular in shape and has a centralorifice.
 12. The surgical stapling instrument according to claim 1,wherein the hook is disposed on at least one of the surgical staplerjaws and has a glass transition temperature at or near a human bodytemperature.
 13. The surgical stapling instrument according to claim 1,wherein the hook is disposed on at least one of the surgical staplerjaws and has a glass transition temperature and further comprising atleast one thermistor for heating the hook to a temperature at or nearthe glass transition temperature.
 14. The surgical stapling instrumentaccording to claim 1, wherein the hook has a first base end and a secondfree end, a diameter of the first base end being greater than a diameterof the second free end so that the second free end is relativelyflexible.
 15. The surgical stapling instrument according to claim 1,wherein the staple line reinforcement material has a plurality offibers, at least one of the surgical stapler jaws having the hook, thehook being arranged to engage one or more of the plurality of fibers.16. A surgical stapling instrument, comprising: a handle assembly; abody portion extending from the handle assembly; surgical stapling jawsincluding a staple cartridge assembly and an anvil assembly disposed ata distal end of the body portion, the staple cartridge assembly having afirst tissue contacting surface and the anvil assembly having a secondtissue contacting surface; a plurality of hooks attached to at least oneof the first tissue contacting surface and the second tissue contactingsurface; and a staple line reinforcement material in engagement with atleast some of the plurality of hooks.
 17. The surgical staplinginstrument according to claim 16, further comprising a staple linereinforcement material defining a plurality of pores, the plurality ofhooks being arranged to engage the staple line reinforcement material inthe plurality of pores.
 18. The surgical stapling instrument accordingto claim 16, wherein the staple line reinforcement material isnon-woven.
 19. The surgical stapling instrument according to claim 16,wherein the staple line reinforcement material is a mesh.
 20. Thesurgical stapling instrument according to claim 16, wherein the fastenerincludes a sheet having a plurality of hooks on a first side and anadhesive on a second side.